Presentation
Dysphagia with gastro-esophageal reflux.
Patient Data
Large gas-filled shadow projecting over the left cardiac shadow with no visualization of the gastric air-bubble under the left hemidiaphragm. suggestive of a large hiatal hernia.
A portion of the fundus and body of the stomach protrudes through the hiatus. The fundus is above the level of the gastro-esophageal junction which is also located above the diaphragm suggestive of mixed hiatus hernia.
Case Discussion
The radiological appearances are most consistent with a mixed hiatus hernia.
The mixed or compound hiatus hernia is the most common type of paraoesophagal hernia. The GEJ is displaced into the thorax with a large portion of the stomach. Large paraoesophagal hernias, with most of the stomach in the thorax, increase the risk for complications such as volvulus, obstruction, and ischemia.
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